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Mendocino County Public Health Department, CA

Description of Sites / Initial Thoughts about the Use of MAPP

Mendocino County has an estimated population of 86,900. The County covers 3,510 square miles (approximately the size of the state of Connecticut) and has about 100 miles of coastline along the Pacific Ocean with its highest peak rising up to about 6,954 above sea level. Only a small percent of the county (less than 3 percent) is flat land, so the hill country and winding roads affect access to care and transportation issues. The geography also affects the linkages that can be made among the communities within the county. There are about 8 to 12 distinct communities throughout the county. In addition to these communities, numerous residents live scattered throughout the hills. In areas outside of the defined communities, the population density is nine people per square mile (frontier is defined as eight people per square mile). A large Indian reservation (Round Valley) is located in the northeastern corner of the county and several smaller reservations are located elsewhere in the county. Race/ethnicity estimates for 2000 are 78 percent white, 15 percent Hispanic, 6 percent Native American, 1 percent other.

The northern area of Mendocino County also covers what is referred to as the "emerald triangle": an area known for marijuana growing. This brings unique public health issues, not only with substance abuse but also with family services. For example, crackdowns by the DEA often result in children needing child protective services when both parents are arrested.

A five-member Board of Supervisors governs the county. Each member represents a distinct geographical district within the county. The Board of Supervisors appoints the Public Health Director and members of the 19-member Public Health Advisory Board (MCPHAB). A part-time medical health officer also reports to the Board of Supervisors and works closely with the Public Health Director. The medical health officer, Dr. Marvin Trotter, also works part-time for the hospital and conducts monthly radio shows about public health issues. His involvement helps to reinforce linkages between the county's department of public health and the broader community.

There are six federally qualified health centers and three hospitals in the county. However, owing to the county's rural nature and isolated communities, uneven access to care continues to be a problem. The entire county was designated as medically underserved for Medi-Cal in 1991.

The county has conducted APEXPH three times (both Parts I and II) since they first started using the process in 1994. The county has produced impressive community health status reports as a result of their APEXPH Community Assessment activities. They anticipate that their ongoing community health assessment activities will be able to feed easily into the CHSA portion of the MAPP process.

Mendocino County is one of 14 public health departments being funded in California by the California Endowment's Community Health Initiative, Partnerships for the Public's Health (PPH), administered by the Public Health Institute. Through this initiative, community partnerships were identified in each county and were funded to undertake strategic planning activities with local public health departments. No process was identified, although coaches and facilitators were provided. In 2000, three community partnerships in Mendocino County were funded for a four-year initiative, with the first year being a planning year. The initiative has two goals: to build capacity of community groups to identify their strengths and assets; and to help health departments improve their overall capacity and specifically their capacity in working with the community.

The three community partnerships in Mendocino County are:

Laytonville: Includes a population of approximately 2,000 in the town, although residents in the surrounding hills have also been engaged. Their work began with a Healthy Start and school-based focus but has expanded. It is very grassroots-oriented and has resulted in building a community hall. The coalition has identified the following priorities: homeless teenagers, the need for a broad-based community assessment that includes economic factors, housing, etc., the need for a central sewer system, and youth activities.

Willits: Addresses a population of about 5,000 in the valley and 12,000 including those in the surrounding hills. They are focusing on access to services and youth issues. They indicated a strong interest in including youth in the MAPP process, perhaps on the advisory group. They noted that a big challenge is how to engage the population in the hills in respectful ways. As one representative stated, "They are out there in the hills for a reason... and they also don't like government at all."

Gualala/Point Arena Action Network: This is a series of coastal communities extending approximately 50 miles from the southern coast of Mendocino County into the northern part of Sonoma County. The estimated population is anywhere between 3,000 and 12,000 (depending on how the numbers are documented). The population varies from wealthy educated populations such as old ranching or logging families and retired CEOs, to lower-income populations such as old fishing families, hippies that migrated from San Francisco after the 1960s, and three Indian reservations. They are isolated geographically by the hills that separate the coast from the rest of the county. The network includes representatives from churches, schools, the clinic, non-profits, etc. They are addressing access to care and transportation issues, as well as youth issues. In addition, they are convening groups that oversee specific issues, such as environmental issues, domestic violence, substance abuse, etc.

The MAPP and PPH initiatives have very similar objectives; in fact, PPH representatives have noted that, "MAPP is an institutionalization of the PPH work." PPH may provide additional funding to assist the county and the communities in undertaking the MAPP process. It must be noted that the three community partnerships only represent a small part of Mendocino County.

MCDPH staff and community participants are exploring how the community partnerships and countywide implementation of MAPP might relate. Currently, they are considering undertaking a countywide implementation of MAPP, as well as three "mini-MAPP" processes in each of the three PPH communities. Information from the mini-MAPP community partnerships (e.g., visioning processes, surveys) would be "rolled up" into the countywide implementation. MCDPH staff recognized that further MAPP activities would need to occur to properly engage and mobilize areas of the county not covered by the three community partnerships. The Fort Bragg community is a Healthy Cities grantee so there may be some connections with that work as well.

The Mendocino County Public Health Advisory Board (MCPHAB) would likely oversee the countywide effort. This board includes representatives from the three community partnerships, the medical society, and other organizations and areas throughout the county. It was first convened in 1995 as one of the results of the first APEXPH Part I process. As they do with other activities, MCPHAB will likely engage other stakeholders and representatives through subcommittees and specific MAPP activities.

Final decisions about how Mendocino County will approach the MAPP process are still being made. County and community representatives were enthusiastic about the potential of MAPP in bringing the work of the three communities together and helping to create "collective thinking" throughout the county. At the same time, some of the community partnership representatives cautioned against starting planning activities all over again—many of them would like to move forward to action.

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Mendocino County, CA Case Study

The case study provides information about the community's experience and process it went through using the MAPP tool, including links to resources used and lessons learned.